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Masked Hypertension, Urinary Albumin Excretion Rate and Echocardiographic Parameters in Putatively Normotensive Type 2 Diabetes Mellitus Patients

¹Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
²Cardiology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

crisbleitao{at}yahoo.com.br

ABSTRACT

OBJECTIVE: To evaluate the impact of masked hypertension (MH) in normotensive type 2 diabetes mellitus (DM) patients on microvascular complications and echocardiographic parameters.

RESEARCH DESIGN AND METHODS: A cross-sectional study was conducted in 135 normotensive patients with type 2 DM. Patients underwent urinary albumin excretion rate (UAER) measurement, echocardiography and 24-h ambulatory blood pressure (BP) monitoring (AMBP). Patients with increased daytime BP levels (135/85 mm Hg) were classified as MH.

RESULTS: The prevalence of MH was 30% (n = 41). Normotensives and MH, based on AMBP, were not different in terms of age, DM duration, smoking habit, BMI, waist circumference, serum creatinine, glycemic or lipid profiles. The office systolic BP was higher in the MH (127.8 ± 7.5 vs. 122.9 ± 10.2 mm Hg, P = 0.003) than normotensive group. UAER was also increased in the MH group [21.3 (2.5 - 1223.5) vs. 8.1 (1.0 - 1143.0) µg/min, P = 0.001], as well as the interventricular septum (1.01 ± 0.15 vs. 0.94 ± 0.13 cm, P = 0.015) and posterior wall thickness (0.96 ± 0.12 vs. 0.90 ± 0.10 cm, P = 0.006). After adjustments for DM duration, sex, smoking, LDL-cholesterol and A1c values, all associations were sustained for daytime systolic BP but not for office systolic BP.

CONCLUSIONS: Type 2 DM patients with MH have higher UAER and enlargement of ventricular walls compared with the normotensive patients according to ABPM. Therefore, ABPM monitoring is important to identify this high-risk group so as to be able to take interventionist measures.

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